994 



HUMAN ANATOMY. 



Fig. 8 



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4 



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passing forward along with the stems from the circumanal region to the inner 

 inguinal or superficial subinguinal nodes. 



The deep lymphatics of the lower extremity take their origin mainly in the 

 muscles and form stems which accompany the blood-vessels. From the net-work 

 of the plantar muscles one or two stems take origin which follow the course of' the 

 plantar arch, ascending to the dorsum of the foot between the first and second 

 metatarsal bones. They then follow the course of the dorsal pedal vessels, receiving 

 the stems which accompany their branches, and then accompany the anterior tibial 



vessels up the leg. After traversing the anterior tibial 

 nodes they pass with the vessels through the foramen in 

 the interosseous membrane, and, continuing their upward 

 course through the popliteal space, terminate in the 

 deeper popliteal nodes. 



Other branches arising in the plantar musculature 

 follow the plantar vessels backward, and, ascending 

 behind the internal malleolus, accompany the posterior 

 tibial vessels. Toward the upper part of the crus they 

 receive the stems which accompany the peroneal vessels 

 and their branches, and terminate, like the anterior 

 stems, in the deeper popliteal nodes. 



From these nodes four large stems issue, and, 

 passing through the hiatus tendineus of the adductor 

 magnus, continue their course up the thigh in company 

 with the femoral vessels. They receive the stems which 

 accompany the various branches of the femoral vessels 

 and terminate above in the deep subinguinal nodes. 

 In addition to these deep femoral lymphatics others 

 occur in the thigh in company with the obturator and 

 sciatic vessels, and the muscles of the gluteal region are 

 drained by stems which accompany the gluteal vessels. 

 All these stems terminate in nodes belonging to the 

 hypogastric group, those accompanying the sciatic ves- 

 sels traversing some small and inconstant nodes situated 

 beneath the pyriformis muscle, while some ten or twelve 

 similar nodes occur along the course of the gluteal stems. 



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^Inguinal 

 nodes 



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^ 



Superficial 

 -sub- 

 inguinal 

 nodes 



X 



Practical Considerations. — T/ie Nodes of the 

 Lower Extremity. — The majority of the lymphatics of 

 the sole of the foot unite with those of the inner side 

 of the dorsum and run with the long saphenous vein to 

 enter the inguinal nodes. A smaller number run up the 

 fibular side of the leg, but most of these cross over the 

 leg or at the ham to join the inner lymphatic vessels. 

 A still smaller number run with the short saphenous 

 vein and empty into the popliteal nodes. The far more 

 frequent occurrence of glandular swellings and abscess in 

 the groin than in the ham is thus easily understood. 

 The popliteal nodes {intercondylar, lying on either 

 side of the popliteal artery between the two heads of 

 the gastrocnemius, and supracondylar, lying deeper and 

 against the back of the femur) are extremely difificult to feel unless they are 

 enlarged, and even then the only one which can be detected is that which lies over 

 the internal popliteal nerve. This node, probably from the constant movement of 

 the knee-joint, is very apt to suppurate as a result of superficial sores about the heel. 

 The intercondylar nodes cannot be felt ; in the first place, because of their deep 

 position, and secondly, because when pressed they become still further forced down 

 between the condyles. The supracondylar nodes lie altogether too deep to be felt 

 by the fingers (Leaf). A small node beneath the fascia close to the point of entry 

 of the short saphenous receives some of the lymphatics that accompany that vein. 



Superficial lymphatic vessels 

 of lower limb ; semidiagrammatic. 

 (Based on figures of Sappey.) 



